Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

HealthPayerIntelligence News

AMGA: Align Quality, Performance across Medicare Advantage, ACOs

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CMS should work to align quality and performance standards across all Medicare programs, including Medicare Advantage (MA) and the Medicare accountable care organization (ACO) initiatives, says AMGA. In a letter issued in response to proposed...

GAO: Medicaid Home, Community Care Create Financial Conflicts

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Home and community-based services (HCBS) programs funded by Medicaid require additional protections from possible financial conflicts of interest, a new GAO report found. Program assessors, including HCBS providers, state and local agencies,...

Provider Health Insurance Fraud Schemes, Settlements Top $310M

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Law enforcement agencies and federal healthcare administrators including HHS, the Office of the Inspector General (OIG), the FBI, and US Attorney's Offices across the country investigated provider healthcare schemes that defrauded Medicare...

Payers Leverage Data, Wellness Benefits to Address Opioid Abuse

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Providing substance use disorder (SUD) treatment options and making investments in beneficiary drug safety is a critical component of wellness programs, considering that the White House deemed opioid abuse a public health emergency in 2017. In...

KY Gets Approval for 1115 Medicaid Waiver with Work Requirements

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Kentucky is the first state to receive approval for a 1115 Medicaid waiver demonstration that adds work requirements in order for able-bodied adults to be eligible for the public health insurance program. The Kentucky Health program demonstration...

Payers Support Integrated Care Services for NC Medicaid Patients

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Payers and provider organizations that support integrated care systems can help lower healthcare costs by addressing the healthcare concerns of vulnerable patient populations, including Medicaid beneficiaries. Several commercial payers have recently...

Humana Becomes Latest Payer to End AHIP Membership

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Humana is the latest commercial payer to end its membership in AHIP, the nation’s largest health insurance trade organization. “Humana has not actively participated in AHIP since early 2017,” a Humana spokesperson told HealthPayerIntelligence.com....

VA Updates Emergency Care Reimbursement, Payment Activities

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The VA has announced that it will expand provider payment eligibility for emergency treatment services and make  administrative and regulatory changes aimed at creating payment process improvements. The January 9th, 2018 rule extends reimbursement...

CMS to Test Medicaid Waiver “Community Engagement” Incentives

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CMS plans to support the addition of “community engagement” incentives to state 1115 Medicaid waivers that contain work eligibility requirements for able-bodied adults, the agency announced in a press release. The new policy guidance...

VA Union: Investigate $90M in Third-Party Contractor Payments

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The American Federation of Government Employees (AFGE) has sent a letter to VA leadership proposing an investigation into $90 million of improper payments made to the third-party contractors of the Veteran’s Choice program. The inquiry...

Outcomes-Based Contracts Offer Payers New Pharmaceutical Options

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Payers may be more willing to provide their beneficiaries with genetic drug therapies that costs hundreds of thousands of dollars if they enter into outcomes-based pharmaceutical contracts that lessen financial risks. An outcomes-based pharmaceutical...

Top 10 Highest Performing Commercial Health Plans

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The top performing commercial health plans in the US for 2017-18 exceeded expectations for customer satisfaction, preventive care, and outcomes of their beneficiaries, according to the National Committee for Quality Assurance (NCQA). NCQA aggregated...

IT Investment to Help VA Speed Claims Administration, Payment

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The Department of Veterans Affairs (VA) has announced new goals for claims administration and a significant investment in health IT tools that will help coordinate payment for community providers. The VA has set the goal of increasing the number...

Considerations for Designing Consumer-Directed Health Plans

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Employers and health plans are rapidly adopting consumer-directed health plans (CDHPs) as a way to lower benefit costs and encourage cost-effective care utilization among beneficiaries. CDHPs are becoming part of many US employers’ efforts...

Expanding Air Ambulance Service May Help Payers Control Costs

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Expanding air ambulance benefits may help payers lower beneficiary premiums and help beneficiaries avoid several thousand dollars in out-of-pocket healthcare spending. An air ambulance costs between $12,000 to $25,000 per flight to account for...

How Payers Can Build a Successful Bundled Payment Strategy

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Bundled payment models are a popular reimbursement option for payers because they present an opportunity to improve healthcare quality, lower costs, and participate in value-based agreements with limited financial risk.   However, if payers...

Proposed Rule Details Association Health Plan Expansion Guidelines

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The Department of Labor (DoL) released a proposed rule that allows small businesses and employee groups to purchase association health plans (AHPs) in lieu of employer-sponsored or individual health insurance. The rule follows an executive order...

Wellness, Preventive Care to Drive Employer Health Plans in 2018

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Employer-sponsored health plans are expected to widely embrace value-based purchasing agreements and patient engagement technologies that improve employee wellness programs and preventive care, according to the National Business Group on Health...

Healthcare Insurance Market Profits May Hold Steady in 2018

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Certain segments of the healthcare insurance market, including employer-sponsored insurance and Medicare Advantage (MA), will help to stabilize payer profitability in 2018, predicts a report by A.M. Best. The gains from these sectors are expected...

Affordable Care Act Changes May Bring a Rocky 2018 for Payers

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2017 was a turbulent year for the Affordable Care Act.  Legislative battles in Congress, fluctuating support from healthcare stakeholders, and threats of repeal have left many payers facing an uncertain future. Even though Congress has not...

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